Provider Demographics
NPI:1770652166
Name:CASTRO, JOANNA G (OTR)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:G
Last Name:CASTRO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 8TH AVE
Mailing Address - Street 2:STE 207
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-3055
Mailing Address - Country:US
Mailing Address - Phone:415-831-4263
Mailing Address - Fax:415-831-4269
Practice Address - Street 1:402 8TH AVE
Practice Address - Street 2:STE 207
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-3055
Practice Address - Country:US
Practice Address - Phone:415-831-4263
Practice Address - Fax:415-831-4269
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT5042225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOT0050420OtherBLUE SHIELD
CAZZZ28673ZMedicare ID - Type Unspecified